The relationship between childhood trauma and overall health

Clinical experts in Maine like Rebecca Hoffmann Frances, LMFT, Director of Clinical Innovation at Maine Behavioral Healthcare, are examining the relationship between Adverse Childhood Experiences (ACEs) and the frequency of physical and mental health conditions in adulthood.

In the past, healthcare professionals have focused on what is wrong with a patient’s health instead of uncovering what has happened to a patient in the past that might be contributing to declining health.

According to the Substance Abuse and Mental Health Services Administration, “ACEs are stressful or traumatic events, including abuse and neglect. They may also include family dysfunction such as witnessing domestic violence or growing up with family members who have substance use disorders. ACEs are strongly related to the development of a wide range of health problems throughout a person’s lifespan, including those associated with substance misuse.”

Evidence suggests that ACEs can have a profound and lasting impact on lifelong health and wellbeing. A study of more than 17,000 middle class Americans by the Centers for Disease Control and Kaiser Permanente revealed that ACEs contribute significantly to negative physical and mental health outcomes in more than 60% of adults.

People who exhibit high risk behaviors, such as behavioral addictions and substance use disorders, also tend to struggle with health conditions like diabetes, heart disease or hypertension. Traditionally, healthcare professionals have focused solely on treating physical health problems. The need to uncover the life experiences that often precede the development of high risk choices is becoming increasingly clear.

We need to get to the core of the problem in order to achieve better health outcomes. The lasting impact of ACEs is generally determined by the amount of natural and professional support a child receives in overcoming overwhelming experiences. “While some kids can bounce back, others may have a difficult time,” says Hoffmann Frances. “ACEs can be difficult or even impossible to prevent as they may include exposure to car accidents, medical procedures, bullying, or the death of a loved one.”

A Pediatric Violence Screening Toolkit developed by Maine Medical Partners and Portland Defending Childhood was developed to help healthcare professionals screen for and address childhood exposure to violence and trauma. Depending on the child’s age, there are two primary screening questions. A positive answer to either will trigger additional questions that are designed to screen for symptoms related to the potentially traumatic event.

“If children screen positively, the primary care doctor can offer them support and pre-emptive guidance, along with treatment by mental health clinicians who are embedded in the same practices, or refer them to a Maine Behavioral Healthcare therapist,” says Hoffmann Frances. “Physicians are beginning to see exposure to trauma more like a chronic disease.” Currently, 13 clinicians trained in evidence-based trauma treatment are embedded in 15 pediatric practices throughout the Maine Behavioral Healthcare service area.

This new lens will support the child and family on an ongoing basis, ensuring that the exposure is addressed and that the family is receiving the support they need to heal. “While some people may not understand or relate to the word ‘trauma,’ many do understand toxic stress. Toxic stress is the result of chronic intense distress on the body.”

Hoffmann Frances emphasizes the importance of “normalizing” stressful events to reduce the stigma of mental health. Physicians can offer help by making parents feel like they are part of the solution. “Challenging behaviors can be part of the normal developmental process, or they can be a signal of distress. As providers, we have to look at all the potential causes for behavior or medical complaints. Without digging deeper and determining the cause, it will be very hard to find an effective solution.”

To support Maine Behavioral Healthcare’s clinical innovation, the United Way recently awarded the organization a $99k grant for the new Children’s Initiative program to address critical deficits in the behavioral and physical health needs of children and adolescents aged 3-18 in the greater Portland community. Maine families are encouraged to connect with MBH’s wide range of excellent services today.